Many Americans in fire- and extreme heat-prone regions realize they're on the front lines of the climate crisis. Yet, when asked what specific health risks they face, many struggle to identify any. If pressed, some will identify the connection between air pollution and pulmonary issues, but that's typically where the responses end.
In recent years, the media has done a good job highlighting the many emerging connections between climate and health. Both mainstream and trade publications will cover major studies on the health implications. During active wildfires, local publications are where experts specifically identify pregnant people as being at heightened risk for preterm birth and other complications. But after the interview, this connection often drops off the radar for the general public, and even healthcare professionals may not associate the preterm deliveries they care for with the wildfires. Especially concerning, most won't think to prepare their patients for the next extreme event.
Opportunities for intervention abound, but are often missed.
Climate Change Negatively Impacts Pregnancy
Pregnancy-related morbidity and mortality cannot be fully avoided, even by patients with the best insurance who receive care in well-resourced hospitals. Throw in exposures to extreme events such as wildfires and heat emergencies, and these baseline risks are substantially worsened. Pregnant patients in underserved urban and rural communities -- whose medical care may not be as robust as that provided to their more privileged exurban peers -- tend to have poorer resilience and less ability to adapt; therefore, they often suffer .
Climate change and the resulting extreme weather is not the only environmental threat to pregnant patients. Studies also show poorer outcomes in patients exposed to polluted air. In California, a of sorts occurred when eight oil and coal power plants were retired. After the plants shut down, preterm birth significantly decreased for people living within 5 km of the plants. This association was found to be greatest among non-Hispanic Black and Asian mothers.
Epidemiologist Bruce Bekkar, MD, and colleagues conducted that included nearly 33,000 births and found that adverse environmental exposures were associated with very poor pregnancy outcomes, including preterm birth and low birth weight. There are many additional studies with similar findings -- and the numbers of such manuscripts are increasing rapidly.
Providers Face Challenges
Pregnancy is a risky undertaking in the best of circumstances. Ob/gyn residents are repeatedly told during training that being pregnant is much riskier for all adverse health outcomes than not being pregnant. Pregnancy leads to altered cardiopulmonary physiology, difficulties with thermal regulation, increased vulnerabilities to hypertension and diabetes, and myriad bleeding disorders.
Physicians overwhelmingly strive to give their pregnant patients the best care and will go to great lengths to accomplish this. However, even recently trained providers have likely received little to no education on the effects of climate events on their pregnant patients.
Ob/gyn and family practice residencies have a daunting amount of material to cover in the limited number of years of training, and adding another subject to this replete pedagogy is frequently resisted by exhausted program directors. Similarly, qualifying and certifying exams have not yet incorporated climate change as a testable category, so program directors may feel little incentive to cover this material.
While many clinicians accept that climate change currently or will eventually affect their patients, about discussing the crisis with their patients. Many providers feel ill-equipped to provide the needed guidance to help their patients about the impacts of climate disruption. Consequently, they retreat to what they know best: the day-to-day care of patients, as if nothing were amiss.
Furthermore, some providers may be self-conscious about how their peers will view them if they stray from their field's core doctrine. Will they be seen as unconventional or as veering into subject matter outside of their lane?
What Healthcare Professionals Can Do
Physicians and other healthcare professionals must step up and embrace their critical role in the climate crisis. This includes educating yourself on the pregnancy-related risks of a warming planet and air pollution, so you can better guide your patients on ways to protect themselves. You should be an advocate within your community. You can do this at the micro level with your patients, at the mezzo level within your hospital systems, and at the macro level with policymakers. If there is an impending heat event, pregnant patients must be informed about cooling strategies; you can and should help them build resiliency.
You can also push hospital leadership to be involved in climate mitigation. Critically, you should inform elected leaders about the significant health effects of the climate crisis and emphasize that nothing short of eliminating dependence on carbon sources of energy will keep our communities safe from the effects of greenhouse gases.
As healthcare professionals, we garner much respect, and it is time we lift up our voices to preserve our communities and protect them from the impact of this public health emergency.
is professor of Obstetrics and Gynecology at Stanford ľֱ School and division director of Stanford Fertility and Reproductive Health. He is also on the board of directors of the American Society for Reproductive Health, and is past president of the Society for Reproductive Endocrinology and Infertility.
The views of the author do not necessarily reflect those of the ľֱ Society Consortium on Climate and Health or its members.